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The Encounter Data Management Lead is responsible for leading AI-driven reconciliation and automation efforts to improve encounter data quality and reduce manual work. In this role, you will own the performance and continuous improvement of AI models used in reconciliation processes. You’ll work across business and technical teams to identify opportunities, optimize outcomes, and scale automation solutions.

This role requires strong experience applying AI in real-world environments, along with the ability to translate data insights into operational improvements. You will report to the Associate Director, Encounter Data Management.

Key Responsibilities:

• Lead initiatives that use AI and automation to improve encounter data accuracy and efficiency
• Monitor and evaluate AI model performance, including reconciliation rates, error trends, and data quality outcomes
• Identify gaps and partner with technical teams to enhance models and improve results
• Analyze complex data issues and use AI-driven insights to determine root causes and solutions
• Collaborate with business and technical partners to prioritize enhancements and automation opportunities
• Communicate AI performance, risks, and progress to stakeholders in a clear, actionable way
• Maintain and prioritize a roadmap of AI improvements, backlog items, and automation initiatives
• Work independently to solve complex problems and make decisions based on data and business impact

Use your skills to make an impact

Required Qualifications

• 4+ years of experience working with AI or machine learning models, including monitoring and improving model performance
• 4+ years of experience working in a healthcare environment
• 2+ years of project or program leadership experience
• Experience using data to identify trends, solve problems, and improve processes
• Ability to work across teams and communicate technical concepts to non-technical audiences

Preferred Qualifications

• Experience working with AI/ML tools, data platforms, or automation technologies
• Familiarity with claims adjudication systems (CAS) or encounter submission platforms such as Edifecs
• Experience supporting or partnering with data science teams
• Background in process automation or transformation initiatives

Additional Information

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 07-31-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.